NPIMap

Organization Active NPI

Counseling & Assessment Clinic of Worcester LLC

  • Community/Behavioral Health Agency
  • Worcester, MA
National Provider Identifier
1487863494
Registry record updated Jul 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COUNSELING & ASSESSMENT CLINIC OF WORCESTER LLC
Practice address
255 Park Ave Ste 804
Worcester, MA 01609
Phone
(508) 756-5400
Fax
(508) 756-5433
NPI assigned
May 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jennifer J Hylton, PSY. D.NPI 1457339699
Title
Executive Director
Phone
(508) 756-5400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Community/Behavioral Health Agency 251S00000X MA Primary

Addresses

Primary practice location

255 Park Ave Ste 804
Worcester, MA 01609

Mailing address

255 Park Ave Ste 804
Worcester, MA 01609-1984
Phone (508) 756-5400

Other identifiers 1

IdentifierTypeStateIssuer
1894196MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090421000146 MA Part B Supplier - Clinic/Group Practice 8820145394 Receives reassigned benefits from 9 practitioners
Practice locations: Worcester, MA; Fitchburg, MA

National Provider Directory

National Provider Directory
Tax ID family
Counseling Assessment Clin4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

255 Park Ave
Ste 412
Worcester, MA 01609
Phone (508) 756-5400

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532304000000",
    "number": "1487863494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 PARK AVE STE 804",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091984",
            "telephone_number": "508-756-5400",
            "fax_number": "508-756-5433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 PARK AVE STE 804",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "01609",
            "telephone_number": "508-756-5400",
            "fax_number": "508-756-5433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNSELING & ASSESSMENT CLINIC OF WORCESTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2018-07-23",
        "status": "A",
        "authorized_official_last_name": "HYLTON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "508-756-5400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY. D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1894196",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.